New analysis has laid bare the varying levels of nurse retention issues in regions across England and health leaders say the findings once again confirm the need for a fully funded workforce plan.
A newly-published report by the Institute for Fiscal Studies (IFS) has examined some of the factors associated with NHS staff, including nurses and midwives, leaving the acute sector.
“The reasons people stay or leave a job role or their employer are complex”
On average, it found that 0.8% of nurses and midwives left the NHS acute sector in England each month between April 2012 and May 2021.
Further analysis showed that during the same time period, London had the highest leaving rate for nurses and midwives in the country (0.96%) compared to the lowest rate in the North East (0.62%).
The report, funded by the NIHR’s Research’s Health and Social Care Workforce Policy Research Unit, highlighted that regions with higher leaver rates among nurses and midwives also typically had a higher healthcare assistant (HCA) leaver rate.
Nurse and midwife and HCA leaver rates were highest in the South East, South West and London, and lowest in the North East.
Regarding the retention levels of internationally recruited nurses, the report found that EU nurses were 43% more likely to leave than British nurses, while non-EU nurses were 28% less likely to leave.
The analysis noted that while this pattern predates the 2016 EU Referendum, the differences in leaving rates between these groups have grown since then.
It added Brexit “may have exacerbated” the qualitative differences, as the gap between the probability of an EU nurse or midwife leaving compared to their British counterparts was 68% higher in 2016-21 than in 2012-15.
“Brexit has led to nurses and midwives who are recruited from overseas being increasingly recruited from non-EU countries rather than EU countries,” said an observation document supporting the report.
“Given the historic differences in retention rates that we find, this change in employment mix could help to boost NHS retention rates going forwards.”
The report follows data from the Nursing and Midwifery Council that showed the number of nurses leaving the profession increased for the first time in recent years, with more than 25,000 allowing their registration to lapse in 2021-22.
Caroline Waterfield, director of development and employment at NHS Employers, part of the NHS Confederation, told Nursing Times that the IFS report provides “additional valuable insight” which can be used to inform work on retention being undertaken within the acute sector.
She said: “We see the report findings complementing the work being led by employers. The reasons people stay or leave a job role or their employer are complex. Local data and intelligence is essential to underpin local action plans.”
The analysis also found that previous sickness absences, of both physical and mental health, are strongly correlated with nurses and midwives leaving the NHS acute sector.
For nurses and midwives, missing 10% of the month off work because of physical sickness was associated with a 13% increase in the likelihood of leaving three months later.
Meanwhile missing 10% of the month because of mental health sickness was associated with a 27% increase in the likelihood of leaving the NHS.
“Nursing staff have endured a decade of real terms pay cuts and thousands have left nursing in the last year alone”
The analysis described that the absence data does not “lend support” to a solution to the issue of retaining staff.
It said: “If people with poor mental or physical health are more likely to leave because of their condition, policies that are aimed at reducing sickness absence without addressing the underlying health of the workforce are likely to be ineffective.
“Policies aimed at improving the mental and physical health of staff would therefore seem much more likely to succeed in boosting retention than other measures aimed at reducing health related absences.”
Researchers also found that across the health service, age was “strongly associated” with leaving decisions and that patterns differed for men and women.
The report highlighted that overall, female staff were most likely to leave the acute sector in their 30s, while male staff leaving rates begin to rise substantially from 55.
Ms Waterfield told Nursing Times that good engagement, communications, team leadership, support for wellbeing and having flexible and predictable working practices were contributing factors to an individual’s experience of work.
She added: “The funding to support the growth of the nursing workforce in recent years has been welcome. However, the scale of vacancies in nursing and allied health professional roles means there is an urgent need to develop, publish and fund a workforce strategy to help address the shorter and longer term workforce requirements.”
The Royal College of Nursing director for England, Patricia Marquis, has also called for a fully funded workforce plan.
She told Nursing Times that the pressure being felt in acute care is being felt “across the whole health and care system”.
She said: “As hospital beds are at bursting point, A&E waits grow, waiting lists are at record levels and social care is bucking. One part of the system cannot cope without the other.
“There is a simple way to address this – invest in the nursing workforce and deliver on a fully funded workforce plan.
“Nursing staff have endured a decade of real terms pay cuts and thousands have left nursing in the last year alone. Patient care is at risk and has to be addressed now.”
A Department of Health and Social Care spokesperson said: “We hugely value the contribution of NHS staff across the country, who are working tirelessly to bust the Covid backlogs – this government-commissioned research has provided vital insight into what more we can do to support and retain them.”
They cited the NHS People Plan, which they said sets out “comprehensive actions” for employers to take to improve staff retention, as well as launching a new international recruitment taskforce “to supply the NHS with a long-term sustainable workforce”.